Provider Demographics
NPI:1700827656
Name:BOURI, LOVEENA S (MD)
Entity Type:Individual
Prefix:
First Name:LOVEENA
Middle Name:S
Last Name:BOURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 PAYSHERE CIR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-0001
Mailing Address - Country:US
Mailing Address - Phone:630-545-6016
Mailing Address - Fax:
Practice Address - Street 1:608 S WASHINGTON ST STE 201
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6661
Practice Address - Country:US
Practice Address - Phone:630-717-2630
Practice Address - Fax:630-355-9546
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112566207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI39991Medicare UPIN